We read with interest the article "-trace protein test: New guidelines for the reliable diagnosis of cerebrospinal fluid fistula" by Meco et al, from the November 2003 issue of Otolaryngology-Head and Neck Surgery. The TP test certainly will offer several diagnostic advantages over 2transferrin in that it is inexpensive, rapid, and potentially applicable to intra-operative use.The authors indicate nasal secretions can be collected at home and stored in a plastic tube for patients with intermittent cerebrospinal fluid leak. We wonder if the authors have serially studied nasal secretions to determine if CSF proteins undergo proteolysis after interacting with natural host defenses present in normal nasal secretions. Nasal mucus contains several proteolytic enzymes, and in patients with sinonasal infection, the offending bacteria may also effect proteolysis. 1 We know that transferrin proteins typically undergo some degree of breakdown upon interaction with lymphocytes and passive immune mediators. 2 Although the rate of proteolysis of 2-transferrin has not been studied, we believe proteolysis of CSF rhinorrhea may decrease sensitivity of this test. If -trace protein-a prostaglandin synthase-is more stable than 2-transferrin, this may be another diagnostic advantage of the new test.Thank you,
Objective:
The aim of the study was to evaluate the predictive value regarding postoperative hearing benefit of electrically evoked auditory brainstem response audiometry in sporadic vestibular schwannoma patients undergoing simultaneous tumor resection and cochlear implantation.
Design:
Patients were included in a prospective study conducted between October 2016 and January 2019.
Setting:
The study was conducted at a tertiary care center.
Participants:
Subjects with unilateral sporadic vestibular schwannoma were screened for study participation. Patients underwent translabyrinthine vestibular schwannoma resection and cochlear implantation simultaneously.
Intervention:
Electrically evoked brainstem response audiometry was performed during surgery before and after tumor removal using an intracochlear test electrode to objectively evaluate nerve conduction.
Main Outcome Measure:
Electrically evoked brainstem response audiometry results were correlated with postoperative sound field audiometry, word recognition tests, and speech reception thresholds. Quality of life was assessed before and 12 months after translabyrinthine tumor removal and cochlear implantation.
Results:
Five patients, three male and two female, were included in the study and followed for at least 1 year after implantation. Three of the five patients are daily cochlear implant users with open set speech recognition. Two individuals with negative intraoperative electrically evoked auditory brainstem response results showed no auditory perception with cochlear implant.
Conclusions:
Simultaneous translabyrinthine vestibular schwannoma resection and cochlear implantation with intraoperative electrically evoked auditory brainstem response measurements is a feasible and promising option for sporadic vestibular schwannoma patients. Preservation of electrically evoked auditory brainstem responses seems to predict good subsequent hearing outcomes.
BackgroundThe antibody-based targeted delivery of bioactive molecules to tumour vasculature is an attractive avenue to concentrate therapeutic agents at cancer sites, while sparing normal organs. L19, F8 and F16 are three fully human monoclonal antibodies, specific to splice isoforms of fibronectin and tenascin-C, which bind to sites of active tissue remodeling and which are currently in Phase I and II clinical trials as radio-immunoconjugates and immunocytokines in patients with cancer and arthritis.In this article, we report the first comparative analysis of expression patterns for the extra domains EDB and EDA of fibronectin and A1 of tenascin-C in both primary and metastatic head and neck cancer lesions.MethodsWe performed a comparative immunofluorescence analysis with the L19, F8 and F16 antibodies in 40 freshly frozen human head and neck cancer specimens.ResultsOn average, F8 and F16 exhibited similar staining intensities, which were typically stronger than L19. Interestingly, some specimens exhibited striking differences in staining by the three antibodies.ConclusionsThese results suggests that an individualized treatment procedure (e.g., choice of L19, F8 or F16 based on immuno-PET or immunofluorescence procedure) may represent the most logical avenue for offering the best possible antibody to any given patient.
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